Competitive procurement of postpayment claims review services and dependent eligibility verification services; public records exemption.

(1) The Division of State Group Insurance is directed to competitively procure postpayment claims review services for the state group health insurance plans established pursuant to s. 110.123. Compensation under the contract shall be paid from amounts identified as claim overpayments that are made by or on behalf of the health plans and that are recovered by the vendor. The vendor may retain that portion of the amount recovered as provided in the contract. The contract must require the vendor to maintain all necessary documentation supporting the amounts recovered, retained, and remitted to the division; and

(2) The department is directed to contract for dependent eligibility verification services for the state group insurance program.

(a) The department or the contractor providing dependent eligibility verification services may require the following information from subscribers:

1. To prove a spouse’s eligibility:

a. If married less than 12 months and the subscriber and his or her spouse have not filed a joint federal income tax return, a government-issued marriage certificate;

b. If married for 12 or more months, a transcript of the most recently filed federal income tax return; or

c. If the documentation specified in sub-subparagraph a. or sub-subparagraph b. cannot be produced, an attestation of the marriage by sworn affidavit consistent with s. 92.50.

2. To prove a biological child’s or a newborn grandchild’s eligibility:

a. A government-issued birth certificate; or

b. If a birth certificate cannot be produced, an attestation of the subscriber-dependent relationship by sworn affidavit consistent with s. 92.50.

3. To prove an adopted child’s eligibility:

a. An adoption certificate;

b. An adoption placement agreement and a petition for adoption; or

c. If the documentation specified in sub-subparagraph a. or sub-subparagraph b. cannot be produced, an attestation of the subscriber-dependent relationship by sworn affidavit consistent with s. 92.50.

4. To prove a stepchild’s eligibility:

a. A government-issued birth certificate for the stepchild; and

b. The transcript of the subscriber’s most recently filed federal income tax return.

5. To prove a child’s eligibility under a guardianship, a copy of the court order naming the subscriber or the subscriber’s spouse as the child’s legal guardian or custodian.

6. To prove a foster child’s eligibility, a copy of the records showing the subscriber or the subscriber’s spouse as the dependent’s foster parent.